Children's anxiety scores drop sharply at first checkup—raising questions about real progress
A major analysis of 9,224 children found that anxiety ratings plummet between initial and follow-up assessments, a pattern researchers attribute to measurement bias rather than genuine improvement. The discovery has immediate consequences for how clinicians and researchers interpret treatment outcomes and could reshape how anxiety interventions are evaluated in pediatric care.
Originaltitel: Initial elevation bias in child anxiety symptoms: A systematic review and meta-analysis.
= 9,224 children) met inclusion criteria: 46 clinical samples, 37 risk samples, and 23 community samples. For child-rated anxiety, a weighted average effect of -0.25 (95% CI [-0.30, -0.21]) was found between the first and second assessments and -0.09 (95% CI [-0.18, -0.01]) between the second and third assessments. Metaregression showed that clinical and risk samples had larger decreases in anxiety scores, while the Screen for Child Anxiety-Related Emotional Disorders measure exhibited smaller decreases. For parent-rated child anxiety, the effect was -0.12 (95% CI [-0.17, -0.06]) between the first and second assessment. The findings support the presence of initial elevation bias mainly in child-reported anxiety. The results are unlikely to be explained by maturation, real improvements, or selective attrition, and they extend beyond the effects of regression to the mean as they appear even in community samples. Initial elevation bias complicates the interpretation of child anxiety ratings and has important implications for clinical practice and research. (PsycInfo Database Record (c) 2026 APA, all rights reserved).